No abstract available.
Masseter Muscle*

Scedosporium apiospermum, an asexual state of Pseudallescheria boydii, is a widely distributed mould that can be found in the soil, manure, stagnant water and decaying vegetation. It has become an emerging pathogen among immunosuppressed patients but it can also cause infections in immunocompetent patients by penetrating trauma. This fungus is a classical cause of mycetoma and the localized skin infections caused by this mould are much rarer than mycetoma. We report a case of cutaneous S. apiospermum infection in a 79-year-old woman. She had erythematous plaque with crust and violaceous supprative nodules on the right forearm. The culture from pus showed typical white to gray colored cottony colonies of S. apiospermum. Treatment was started with voriconazole effectively. Skin lesions completely cured with no reccurence. Thus, voriconazole shows to be an effective treatment for Scedosporium infection.
Female ; Forearm ; Fungi ; Humans ; Manure ; Mycetoma ; Pseudallescheria ; Pyrimidines ; Scedosporium ; Skin ; Soil ; Suppuration ; Triazoles

Washboard nail is a dystrophy that presents as a series of ridges that extends across the nail. It is often accompanied by a central depression that extends from the cuticle to the free edge. Washboard nail is often a result of frequently repeated trauma, but sometimes predisposing factors cannot be found. When habitual tic is the cause of the lesions, restraining the habit is the most important treatment. Here, we report a case of a 6-year-old male with washboard nails on both thumbnails and was treated with topical 0.1% tacrolimus ointment. Significant improvement was observed after 4 months of application. This case suggests that topical tacrolimus can be considered as a primary therapy in the treatment of washboard nails in the absence of trauma.
Depression ; Humans ; Male ; Nails ; Tacrolimus ; Tics

Recent evidence has suggested that human skin fibroblasts may represent a novel source of therapeutic stem cells. In this study, we report a 3-stage method to induce the differentiation of skin fibroblasts into insulin-producing cells (IPCs). In stage 1, we establish the isolation, expansion and characterization of mesenchymal stem cells from human labia minora dermis-derived fibroblasts (hLMDFs) (stage 1: MSC expansion). hLMDFs express the typical mesenchymal stem cell marker proteins and can differentiate into adipocytes, osteoblasts, chondrocytes or muscle cells. In stage 2, DMEM/F12 serum-free medium with ITS mix (insulin, transferrin, and selenite) is used to induce differentiation of hLMDFs into endoderm-like cells, as determined by the expression of the endoderm markers Sox17, Foxa2, and PDX1 (stage 2: mesenchymal-endoderm transition). In stage 3, cells in the mesenchymal-endoderm transition stage are treated with nicotinamide in order to further differentiate into self-assembled, 3-dimensional islet cell-like clusters that express multiple genes related to pancreatic beta-cell development and function (stage 3: IPC). We also found that the transplantation of IPCs can normalize blood glucose levels and rescue glucose homeostasis in streptozotocin-induced diabetic mice. These results indicate that hLMDFs have the capacity to differentiate into functionally competent IPCs and represent a potential cell-based treatment for diabetes mellitus.
Animals ; Biological Markers/metabolism ; *Cell Culture Techniques ; *Cell Differentiation ; Cell Proliferation/drug effects ; Cell Separation ; Cells, Cultured ; Dermis/*cytology/drug effects ; Diabetes Mellitus, Experimental/*surgery ; Female ; Fibroblasts/*cytology/drug effects ; Genitalia, Female/*cytology ; Glucose/metabolism ; Hepatocyte Nuclear Factor 3-beta/metabolism ; Homeodomain Proteins/metabolism ; Humans ; Insulin/pharmacology/secretion ; Insulin-Secreting Cells/*cytology/metabolism ; *Islets of Langerhans Transplantation ; Mesenchymal Stem Cells/*cytology/drug effects/metabolism ; Mice ; Mice, Nude ; Niacinamide/pharmacology ; Recovery of Function ; SOXF Transcription Factors/metabolism ; Sodium Selenite/pharmacology ; Trans-Activators/metabolism ; Transferrin/pharmacology

Although the incidence of bleeding complications during extracorporeal membrane oxygenator (ECMO) support has decreased in various trials, bleeding is still the most fatal complication. We investigated the ideal dosage and efficacy of nafamostat mesilate for use with ECMO in patients with acute cardiac or respiratory failure. We assessed 73 consecutive patients who received ECMO due to acute cardiac or respiratory failure between January 2006 and December 2009. To evaluate the efficacy of nafamostat mesilate, we divided the patients into 2 groups according to the anticoagulants used during ECMO support. All patients of nafamostat mesilate group were male with a mean age of 49.2 yr. Six, 3, 5, and 3 patients were diagnosed with acute myocardial infarction, cardiac arrest, septic shock, and acute respiratory distress syndrome, respectively. The mean dosage of nafamostat mesilate was 0.64 mg/kg/hr, and the mean duration of ECMO was 270.7 hr. The daily volume of transfused packed red blood cells, fresh frozen plasma, and cryoprecipitate and the number of complications related to hemorrhage and thrombosis was lower in the nafamostat mesilate group than in the heparin group. Nafamostat mesilate should be considered as an alternative anticoagulant to heparin to reduce bleeding complications during ECMO.
Acute Disease ; Anticoagulants/*administration & dosage ; Dose-Response Relationship, Drug ; *Extracorporeal Membrane Oxygenation ; Female ; Guanidines/*administration & dosage ; Heart Failure/diagnosis/mortality/therapy ; Heparin/administration & dosage ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/mortality/therapy ; Respiratory Distress Syndrome, Adult/diagnosis/mortality/therapy ; Retrospective Studies ; Shock, Septic/diagnosis/mortality/therapy ; Survival Analysis

Perforating pseudoxanthoma elasticum is a rare disorder. It is an hereditary connective tissue disease involving progressive fragmentation and dystrophic calcification of elastic fibers. The localized lesions usually occur in a periumbilical location in obese, middle-aged, multiparous black women. It is characterized clinically by yellowish, lax, well-circumscribed, reticulated or cobblestoned patches or plaques of the periumbilical region. Herein, we report a case of periumbilical perforating pseudoxanthoma elasticum which occurred in an obese, multiparous woman with no signs of hereditary systemic pseudoxanthoma elasticum.
Connective Tissue Diseases ; Elastic Tissue ; Female ; Humans ; Pseudoxanthoma Elasticum*

BACKGROUND: IgA nephropathy (IgAN) is the most frequent primary glomerulonephritis in the world. Despite 20 years of research into this condition, much remains unknown about its pathogenesis and therapy. One major problem is that the prognostic evaluation and renal survival of IgAN is unreliable. METHODS: A retrospective study was performed to clarify the prognostic factors and the long-term renal survival rates of this disease. RESULTS: One hundred fifty-two patients with IgAN who followed-up at least 3 years after renal biopsy were included in this study. During a mean followed-up of 9.3 years after their renal biopsy (range:36-215 months), 33 of them (21.7%) had progressed to end-stage renal disease (ESRD). The actuarial renal survival rate was 97% at 5 years, and 85% at 10 years. Using univariate analysis, 5 risk factors for developing ESRD were identified:male sex, hypertension, heavy proteinuria, renal insufficiency at the time of biopsy, severe histopathologic findings such as subclass IV/V lesions by Haas' subclassification were associated with significant risk factors for developing ESRD. In multivariate regression analysis, only Haas' subclass IV/V lesions and renal insufficiency at the time of biopsy were the independent prognostic factors of IgAN. CONCLUSION: In conclusion, further long-term prospective study with larger number of patients would be necessary to assess the prognostic factors in IgAN.
Biopsy ; Glomerulonephritis ; Glomerulonephritis, IGA ; Humans ; Hypertension ; Immunoglobulin A* ; Kidney Failure, Chronic ; Prognosis* ; Proteinuria ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Survival Rate

The prevalent ages at onset for Kawasaki Disease (KD) and Epstein-Barr virus (EBV) infection are known to be similar in Korea and Japan. We evaluated the correlation between EBV infection and KD. The antibodies to EBV such as anti-viral capsid antigen (VCA) IgG and IgM, anti-diffuse and restricted early antigen IgG (anti-EADR IgG), and the anti-EBV determined nuclear antigen IgG (anti-EBNA IgG) were examined in 29KD patients at five separate times sequentially during a period of one year, and also in 14 other children with a past history of KD. The results of each group were compared with those of age-matched controls. The positive rates of anti-VCA IgG and IgM at presentation in the KD patients were 41.4% (12/29) and 0% (0/29), respectively. Only one patient was found to be anti-VCA IgM-positive within two months. There were no cases of anti-VCA IgG except one, anti-EADR IgG and anti-EBNA IgG positive to negative seroconversion during the year. The children with a past history of KD showed higher anti-EBNA IgG-positive rates than the controls (p=0.04). There was no difference in the seropositive rates of the antibodies to EBV, cytomegalovirus, herpes simplex virus and herpes zoster virus. In conclusion, children with KD were noted to have normal immune responses to EBV infection. Children with a past history of KD seemed to be infected with EBV at a later age than children with no history of KD.
Mucocutaneous Lymph Node Syndrome/*virology ; Male ; Korea ; Infant ; Immunoglobulins/metabolism ; Immunoglobulin M/chemistry ; Immunoglobulin G/chemistry ; Humans ; Herpesvirus 4, Human/*metabolism ; Female ; Epstein-Barr Virus Infections/*complications ; Child, Preschool ; Antibodies, Viral/*chemistry ; Age of Onset

OBJECTIVE: For evaluation of prevention program for neonatal vertical transmission from HBsAg positive mother in Korea METHODS: From January 15th to February 15th 2003, the status of neonatal vaccination, immunoglobuline injection and breast feeding of HBsAg positive mother was evaluated by using mailed questionnaire in 848 hostpitals with more than 100 deliveries in the year of 2001. 341 out of 848 (40.2%) hospitals returned questionnaires. RESULTS: 91.9% of total hospital reported that the vaccination of hepatitis B and immunoglobulin injection was done within 12 hours after birth in more than 90% of neonate. The most commonly used vaccine type was 0-1-6 method. In case of unknown result of HBsAg/ HBsAb in mother, 84.4% of hospitals delayed immunoglobulin injection until complete report, however 63% of hospitals gave hepatitis vaccine without delay before complete result. The breast feeding of HBsAg positive mother was recommended according to the result of HBeAg in 66.3% of hospitals while 24.9% of hospitals recommend breast feeding. CONCLUSION: Most hospitals in Korea reported that vaccination of Hepatitis B and immunoglobulin injection was done within 12 hours after in over 90% of neonate whose mother was HBsAg Positive. But continuous education and careful monitoring are required for injection method and vaccination policy in neonates of mothers with unknown result of HBsAg/HBsAb of mother.
Breast Feeding ; Education ; Hepatitis ; Hepatitis B ; Hepatitis B e Antigens ; Hepatitis B Surface Antigens* ; Humans ; Immunoglobulins ; Infant, Newborn ; Korea* ; Mothers* ; Parturition ; Postal Service ; Surveys and Questionnaire ; Vaccination

Metastatic brain tumors from gastric cancer are extremely rare. A 61-year-old Korean woman, initially presenting with polydipsia and polyuria, was found to have metastatic lesions in the brain by MRI. We performed several diagnostic procedures to determine the origin of the brain metastases. She was revealed to have a soft tissue mass of the right adrenal gland and fungating ulcers in the stomach. Histologic studies of both the adrenal gland mass and gastric tissues revealed malignant tumors composed of anaplastic cells. Based on the electron microscopy study, the malignant tumor of the right adrenal gland was a metastatic lesion from the anaplastic carcinoma of stomach. Therefore, the malignant tumors of the brain were assumed to have originated from the gastric cancer. This case report is presented to make clinicians aware of the possibility that diabetes insipidus (polydipsia) may present as an initial manifestation of brain metastases.
Adrenal Gland Neoplasms/diagnosis/*secondary ; Brain Neoplasms/diagnosis/*secondary ; Carcinoma/*diagnosis ; Diabetes Insipidus/*etiology ; Female ; Humans ; Middle Aged ; Stomach Neoplasms/*diagnosis